Description
General Summary of Position
Utilizes departmental software programs, including Microsoft Word to compose reports from data analysis, Microsoft PowerPoint to present comprehensive visuals, and Microsoft Excel to convert data from text files into an importable format to transfer data to a Microsoft Access database or a Microsoft Excel spreadsheet. Completes reconciliations of Excel spreadsheets to ensure data is accurate. Prepares and submits various daily, weekly, and monthly departmental reports for oversight using Microsoft Excel and other tools as assigned. Utilizes Microsoft Excel and other organization-based reporting tools and applications to abstract, create, provide detail, summarize, and trend data per departmental requests. Supports the MedStar Family Choice Department of Appeals/Grievances/ER Reviews for Maryland Appeals and Grievances, and DC Appeals by building/updating dashboards and reports using Tableau, SQL Server Reporting Services, and other systems interfacing with and required to build reports including advanced data visualizations and interactive features in Tableau. Specifically, position responsibilities include data collection requirements for reports and dashboards, acquiring and managing datasets, developing and publishing reports and dashboards, performing ad hoc analysis, composing report summaries, and delivering data-driven suggestions based on their findings to the Manager of Appeals/Grievances/ER Reviews for oversight. Consults directly with business users, clinicians, analysts, and decision-makers to gather reporting requirements and translate business requirements into functional specifications to implement and update reports and dashboards. Manages Maryland and District of Columbia member/enrollee and provider medical appeals, complaints, and grievances. Responsible for member/enrollee advocate functions. Interacts directly with members/enrollees, staff, physicians, and others on the telephone to resolve issues. Acts as a resource and documents all information as it relates to medical appeals, complaints, and grievances. Assists with the collection of quality improvement information via telephone. Responsible for accurate computer data input, tracking, trending, clerical, survey processing, outbound calls, and correspondence as expected. We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.
Primary Duties and Responsibilities
Minimum Qualifications
Education
- High School Diploma or GED required and
- Associate's degree Computer science, analytics, or a related field. required
- One year of relevant education may be substituted for one year of required work experience.
Experience
- 3-4 years At least 3-4 years of analytics and data visualization experience, with a demonstrated ability to query, clean, blend, validate aggregate, and analyze large datasets to create and update reports and dashboards. required and
- 3-4 years Customer service experience in a managed care or social service setting required and
- 3-4 years Medical appeals processing, medical billing claims, auditing, and COB experience. preferred and
- 3-4 years Demonstrates ability to create advanced data visualizations in Tableau and SQL is preferred. Experience with relational databases and SQL. preferred
- One year of relevant professional-level work experience may be substituted for one year of required education.
Knowledge, Skills, and Abilities
- Detail oriented, excellent verbal and written communication and organizational skills
- Under general supervision of the Grievance and Appeals Manager performs a variety of complex, responsible and confidential duties requiring a thorough knowledge of organizational procedures and precedents perform routine clerical, administrative duties in support of the Grievance and Appeal Department.
- Attention to detail.
- Excellent time management and organizational skills ability to manage high volume of work assignments effectively
- Strong analytical and research skills.
- Ability to type 40 words per minute.
- Filing skills.
- Knowledge of claims processing and medical billing.
- Knowledge of managed care/healthcare industry preferred.
- Ability to process complex business rules simultaneously to render decisions.
- Logical reasoning and deduction skills for error and problem resolution.
- Excellent interpersonal and customer service skills.
- Strong quantitative analytic skills with an aptitude for analyzing large data sets.
- High proficiency with data management and visualization tools such as SQL and Tableau.
- Solid working knowledge of word processing, spread sheet and database management computer software and applications.
- Passion for analytics with the desire to help drive immediate improvement in business results based on the data analysis.
- Proven ability to prioritize work, manage multiple competing priorities, and work in a fast-paced environment with a high volume of time-sensitive information.
- Ability to work effectively independently, work with very little supervision and in a team environment.
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:
- Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
- Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
- More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
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